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All ED drugs are available in different strengths, the medium one being the default starting dose for otherwise healthy patients. Higher strengths are intended for those patients who don’t respond to treatment with the standard dose. Lower strengths are intended for patients who experience unwanted side effects with higher doses or have medical conditions or take drugs known to interact with ED meds.
Viagra is available as 25mg, 50mg and 100mg tablets with the prices from $59.93 per brand-name pill in the US to $0.33 per pill of generic sildenafil online. Levitra comes in three strengths too – 5mg, 10mg and 20mg, the prices ranging between $56.08 and $0.49 correspondingly. Cialis for daily use is available as 2.5mg or 5mg pills costing $0.40 to $11.57 each. When taking tadalafil as needed, the patients choose between 5mg, 10mg and 20mg, the prices ranging between $0.23 and $72.14 per pill.
The prices of ED meds are different in different countries because of varied paying capacity of customers, levels of competition in the market, government control over pharmaceutical market or lack thereof and varied access to health insurance. ED patients can save money by buying generics that are up to 99% cheaper than brand-names. This is because their manufacturers face much lower expenses than the inventors of the original brand-name drugs and pass the savings to the consumer. Another way to save is by splitting pills. Note this should be done after obtaining the doctor’s permission, by means of a special tool and, preferably, with scored pills that are designed to allow accurate splitting.

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Viagra, Levitra, Cialis: Prices, Available Strengths and How to Choose the Right One

This article focuses on the prices of Viagra, Levitra and Cialis in different countries of the world and covers the factors defining them. It also lists the strengths these 3 medications are available in. The strength is the amount of active substance per tablet. For example, Viagra is available in the strengths of 25mg, 50mg and 100mg, with each tablet containing 25mg, 50mg and 100mg of sildenafil respectively. The appropriate strength of medication is selected for every patient individually based on their:

Viagra Prices and Available Strengths

Viagra is a medication used to treat erectile dysfunction. The active ingredient used in it is sildenafil. Viagra entered the market in 1998 becoming the first ever ED drug from the group of PDE-5 inhibitors. In 2016, its net sales totaled $1.564 Bn meaning its share of the $4.35 Bn global market of ED drugs was roughly 36%. Today Viagra’s market share is decreasing as alternative PDE-5 inhibitors (vardenafil, tadalafil, avanafil, udenafil and more) and cheaper sildenafil-based generics become available in the US, EU, UK, Canada and Australia. The lowest-priced generics are up to 99% cheaper than brand-name Viagra with its out-of-pocket cost of around $60 a pill in the US.

PDE-5 Inhibitors are a group of medications used to treat erectile dysfunction. PDE-5 (phosphodiesterase type-5) is a naturally occurring enzyme responsible for narrowing the blood vessels in the penis when the sexual intercourse is over. By temporarily deactivating this enzyme, PDE-5 inhibitors stimulate healthy lasting erections in men with erectile dysfunction.

Viagra 50mg

The 50mg is the default strength prescribed to those patients with ED who don’t have any contraindications to using Viagra. According to Pfizer’s data, 80% of patients taking the 50mg pills manage to get erections hard enough for penetrative intercourse.

Although the maximum recommended dosage of Viagra is 100mg/day, it should not be taken more often than once in 24 hours. This applies to the 50mg pills too – do not take them more frequently than once daily.

Viagra 50mg prices
Country Out-of-pocket price per pill
US $59.93
UK $9.06
India $4.93
South Africa $1.51
Lowest online price on PharmacyChecker.com (brand-name Viagra) $6.13
Lowest online price on PharmacyChecker.com (generic sildenafil) $0.35

Viagra 100mg

Viagra 100mg is intended for those patients who can’t get a proper erection on the 50mg pills. According to Pfizer, Viagra 100mg is effective in 85% of the patients. Studies like the ones by M. Kirby et al and J. Buvat et al show that increasing the dose from 50mg to 100mg does not increase the frequency or severity of side effects.

Viagra 100mg prices
Country Out-of-pocket price per pill
US $59.93
UK $10
India $6.32
South Africa $3.02
Lowest online price on PharmacyChecker.com (brand-name Viagra) $5.86
Lowest online price on PharmacyChecker.com (generic sildenafil) $0.40

Viagra 25mg

The 25mg dosage is intended for ED patients who experience serious side effects after taking Viagra 50mg as well as for patients with the following conditions:

Viagra interacts with the drugs listed below, so don’t take more than 25mg if you use any of these:

Viagra 25mg prices
Country Out-of-pocket price per pill
US $59.93
UK $6.59
India N/A
South Africa $1.36
Lowest online price on PharmacyChecker.com (brand-name Viagra) $7.56
Lowest online price on PharmacyChecker.com (generic sildenafil) $0.33

Levitra Prices and Available Strengths

Levitra is an ED medication containing PDE-5 inhibitor vardenafil. Vardenafil was discovered in 1990 and released into the US market in 2003. Levitra is available in two dosage forms – tablets and quickly disintegrating oral strips (sold as Levitra Soft or Staxyn). Its global market share was roughly 5.7% in 2015-2016. Like with Viagra, Levitra’s popularity keeps decreasing as generics and new similar medications find their way into the market. However, a market forecast by Grand View Research suggests that Levitra’s share of the market will start increasing after an all-time low in 2019.

Levitra 10mg

This is the default strength with each pill containing 10mg of vardenafil. It is prescribed to first-time ED patients who don’t have any health complications and don’t take any medications that could require a Levitra dosage adjustment. To be taken as needed, about 1 hour before expected sexual activity. Separate doses should be taken at least 24 hours apart.

Levitra 10mg prices
Country Out-of-pocket price per pill
US $56.08
UK $6.10
South Africa $5.07
Lowest online price on PharmacyChecker.com (brand-name Levitra) $9.58
Lowest online price on PharmacyChecker.com (generic vardenafil) $0.55

Levitra 20mg

The 20mg Levitra pills and oral strips are intended for those patients who don’t get an erection after taking the standard 10mg dose. 20mg is the maximum recommended daily dose of vardenafil and one should never exceed it to avoid overdose.

Placebo-controlled tests show that the incidence and severity of side effects of Levitra including headache, stomach upset, flushing, nausea and rhinitis are higher with 20mg pills compared to treatment with 10mg and 5mg Levitra.

Levitra 20mg prices
Country Out-of-pocket price per pill
US $56.08
UK $10.79
South Africa $10.13
Lowest online price on PharmacyChecker.com (brand-name Levitra) $5.58
Lowest online price on PharmacyChecker.com (generic vardenafil) $0.49

Levitra 5mg

The 5mg version of Levitra is prescribed to the following groups of patients:

Levitra 5mg prices
Country Out-of-pocket price per pill
US $56.08
UK $4.82
South Africa $2.53
Lowest online price on PharmacyChecker.com (brand-name Levitra) $7.46
Lowest online price on PharmacyChecker.com (generic vardenafil) N/A

Cialis Prices and Available Strengths

Cialis is an erectile dysfunction medication by Eli Lilly and Company that uses tadalafil as its active ingredient. It is the only PDE-5 inhibitor with a low-strength version designed for daily use and approved for treatment of concomitant ED and benign prostatic hyperplasia .What also sets Cialis apart from other similar medications is the duration of effect – while Levitra and Viagra work for 4-5 hours after being taken, the half life of Cialis exceeds 17 hours. Benign prostatic hyperplasia – a condition when the prostate gland becomes enlarged causing such urinary symptoms as increased micturition frequency or urgency, incomplete voiding, weak urine stream, etc.

According to a 2016 report by Eli Lilly, its global Cialis revenue was over $2.4 Bn meaning that the drug’s global market share exceeded 56%. The numbers are expected to drop in 2019 following the expiry of Eli Lilly’s patent for tadalafil in late 2018.

Cialis 5mg

Cialis 5mg is the starting dosage for treatment of erectile dysfunction or concomitant ED and BPH. It is intended for daily use –1 pill to be taken at approximately the same time every day. The daily regimen is optimal for men expecting to engage in sexual intercourse twice a week or more frequently. Patients with no urinary symptoms due to BPH who have sex less often than twice weekly are recommended to consider treatment with Cialis 10mg or 20mg for use as needed.

Additionally, Cialis 5mg is used as the reduced dosage for treatment as needed in the patients who can’t take the 10mg pills due to serious side effects.

Cialis 5mg prices
Country Out-of-pocket price per pill
US $11.57
UK $3.04
South Africa $2.48
Lowest online price on PharmacyChecker.com (brand-name Levitra) $3.03
Lowest online price on PharmacyChecker.com (generic vardenafil) $0.40

Cialis 2.5mg

The lower-strength 2.5 pills are prescribed to patients with ED or ED+BPH in the following cases:

According to a study by R. Shabsigh et al, the efficacy of 2.5mg Cialis in fighting erectile dysfunction is only slightly lower than that of 5mg Cialis – 45.7% vs 55.2% on first-attempt sexual encounters. Due to that, sources like RX List recommend 2.5mg as the starting dose for daily regimen.

Cialis 2.5mg prices
Country Out-of-pocket price per pill
US $11.57
UK $2.95
South Africa $1.09
Lowest online price on PharmacyChecker.com (brand-name Levitra) $3.98
Lowest online price on PharmacyChecker.com (generic vardenafil) $0.44

Cialis 10mg

This is the dosage prescribed to first-time Cialis users who prefer to take Cialis as needed, not every day. One 10mg pill is taken before the expected sexual intercourse. The effect of Cialis taken as needed lasts for 17-36 hours, so it’s not necessary to take it shortly before sex. When taken in advance, Cialis will not cause spontaneous erections as sexual stimulation is required for it to work.

Cialis 10mg prices
Country Out-of-pocket price per pill
US $72.14
UK $10.42
South Africa N/A
Lowest online price on PharmacyChecker.com (brand-name Levitra) $13.63
Lowest online price on PharmacyChecker.com (generic vardenafil) $0.33

Cialis 20mg

Cialis 20mg is the dosage intended for the patients unable to achieve satisfactory erection quality on the 10mg pills. The study by Ying Lu Guo et al showed that the 20mg pills improve erection quality in 86% of the patients compared to 81% for the 10mg pills. A similar study by Gerald B. Brock et al showed even higher difference of 81% vs 67% respectively.

Cialis20mg prices
Country Out-of-pocket price per pill
US $72.14
UK $10.64
South Africa $8.89
Lowest online price on PharmacyChecker.com (brand-name Cialis) $10.46
Lowest online price on PharmacyChecker.com (generic tadalafil) $0.23

Why Are ED Drugs Priced Differently in Different Countries?

The tables above show that the prices of ED drugs vary significantly from country to country. According to the study by Judith L. Wagner and Elizabeth McCarthy, the reasons for this are the following:

  1. Buyers’ paying capacity in different countries is different – for example, few people in low-income countries like India can buy Viagra at the price charged for it in high-income countries like the US;
  2. Competition brings prices down – the prices of brand-name drugs are higher in countries where they are patent-protected and don’t have to compete against generics;
  3. Wide health insurance coverage brings prices up – in countries where most people have public or private health insurance, medications cost more compared to countries where people pay for their medical expenses out of pocket;
  4. Pricing models are different in different markets – for example, Canada and South Africa have maximum prices for all medications set on the government level while in the USA they are defined by the free market principles.

Why Are Generic ED Drugs So Much Cheaper Than Brand-Names?

According to the US FDA, generic medications are typically up to 85% cheaper than their brand-name alternatives. The tables above show that the difference exceeds 99% when comparing the prices ofbrand-names in the US and the prices of generics sourced from abroad. Such difference is due to multiple factors listed below:

  1. Pharma companies making brand-name meds are trying to make it economically viable. The average cost of developing a new medication exceeds $2.7 Bn, so setting the prices at dozens or even hundreds of dollars per dose during the period of patent protection is the only way to stimulate pharmaceutical companies to continue searching for new drugs.
  2. Generic manufacturers spend less on research, efficacy/safety trials and marketing. They just copy brand-name drugs and get them out into the market with an existing demand for their product.
  3. Generic manufacturers spend less on production. Generic pharmaceutical sector is very developed in countries like India and China where industrial and labor expenses are lower compared to developed countries. This also contributes to the final product’s low price – $0.30-$0.50 per pill in the case of ED drugs.

Splitting Pills Saves Money – But Is It Safe?

The price difference between different strengths of the same medication is minimal. In the US, for example, 100mg Viagra costs as much as the 50mg pill. Simply buying the 100mg pill and splitting it in two would make each separate 50mg dose twice cheaper. However, there are safety concerns associated with pill splitting as by breaking the pill into uneven parts patients end up with doses that are too low or too high. This is a dangerous practice, especially with meds that have a narrow therapeutic-toxic range. To stay safe, follow the steps below before splitting pills:

  1. Ask the doctor or pharmacist if it is okay to split your pills;
  2. Use a special pill splitting device – it’s cheap and accurate;
  3. When choosing between different brands of the same medication, pick the tablets with a score line, if available – they are made to be split.

With each major ED medication available in several strengths, it’s important to take the process of choosing the right one seriously. ED patients are strongly recommended to discuss their medical history and current drug regimen with the doctor to make sure they are prescribed the correct version of the medication.Be aware of the price difference between brand-name and generic ED drugs as well as between the ones available domestically and from abroad. Generics are as safe and effective as brand-names, but it is important to choose the generic medication and the pharmacy to buy it from carefully to avoid running into counterfeits.

Sources:

  1. Pfizer’s Viagra revenue, 2003 to 2017 - https://www.statista.com/statistics/264827/pfizers-worldwide-viagra-revenue-since-2003/
  2. The global market of erectile dysfunction meds, 2016 data by Transparency Market Research - https://www.transparencymarketresearch.com/pressrelease/erectile-dysfunction-drugs.htm
  3. Viagra’s North American market share, 2012-2022 (forecast data) - https://www.grandviewresearch.com/industry-analysis/erectile-dysfunction-drugs-market
  4. Generic sildenafil price comparison - https://www.pharmacychecker.com/sildenafil/50+mg/
  5. Choosing the right dose of Viagra, a guide from Pfizer - https://www.viagra.com/taking/finding-the-right-dose
  6. Viagra price comparison in the US - https://www.goodrx.com/viagra?dosage=100mg&form=tablet&label_override=Viagra&quantity=1
  7. Viagra price comparison in the UK - https://www.doctorfox.co.uk/erectile-dysfunction/viagra.html#tab-6
  8. Viagra 50mg price in India - https://www.practo.com/medicine-info/viagra-50-mg-tablet-27428
  9. Viagra, Levitra, Cialis prices in South Africa - http://www.mpr.gov.za/PublishedDocuments.aspx
  10. Viagra price comparison online - https://www.pharmacychecker.com/viagra/
  11. Sildenafil 50mg price comparison online - https://www.pharmacychecker.com/sildenafil/
  12. M Kirby et al, Erectile function, erection hardness and tolerability in patients treated with sildenafil 50mg and sildenafil 100mg - https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.12229
  13. J Buvat et al, Comparison of efficacy and tolerability of sildenafil 50mg and 100mg in patients with erectile dysfunction - https://www.ncbi.nlm.nih.gov/pubmed/18710446
  14. Discovery and development of PDE-5 inhibitors - https://en.wikipedia.org/wiki/Discovery_and_development_of_phosphodiesterase_5_inhibitors#Discovery
  15. K Neumeyer and P Kirkpatrick, Vardenafil and tadalafil - https://www.nature.com/articles/nrd1362
  16. Levitra net sales, 2015 - https://www.getroman.com/blog/generic-levitra/
  17. Dose effect on the tolerability of Levitra - https://www.rxlist.com/levitra-side-effects-drug-center.htm#consumer
  18. Levitra price comparison in the US - https://www.goodrx.com/levitra?dosage=10mg&form=tablet&label_override=Levitra&quantity=1
  19. Levitra price comparison in the UK - https://www.doctorfox.co.uk/erectile-dysfunction/levitra.html#tab-6
  20. Levitra price comparison online - https://www.pharmacychecker.com/levitra/
  21. Vardenafil 20mg price comparison online - https://www.pharmacychecker.com/vardenafil/
  22. Cialis net sales, 2016 - https://www.prnewswire.com/news-releases/lilly-reports-fourth-quarter-and-full-year-2016-results-300399378.html
  23. Cialis price comparison in the US - https://www.goodrx.com/cialis?dosage=10mg&form=tablet&label_override=Cialis&quantity=1
  24. Cialis price comparison in the UK - https://www.doctorfox.co.uk/erectile-dysfunction/cialis.html#tab-6
  25. Cialis price comparison online - https://www.pharmacychecker.com/cialis/
  26. Tadalafil 20mg price comparison online - https://www.pharmacychecker.com/tadalafil/
  27. R Shabsigh et al, Efficacy of 2.5mg and 5mg tadalafil once daily in treatment of erectile dysfunction - https://www.ncbi.nlm.nih.gov/pubmed/19657349/
  28. Cialis 2.5mg recommended as the starting dose for daily treatment regimen - https://www.rxlist.com/cialis-drug.htm#indications
  29. Y L Guo et al, Compared efficacy of tadalafil 10mg and tadalafil 20mg - https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1442-2042.2006.01393.x
  30. G B Brock et al, Compared efficacy and safety of different strengths of tadalafil - https://www.usrf.org/news/030303_PDE5_inhibitors/Tadalafil_JUrol.pdf
  31. US FDA on price differences between brand-name medications and generics - https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/genericdrugs/ucm167991.htm
  32. The price of developing a new medication exceeds $2.7 Bn - https://www.forbes.com/sites/matthewherper/2017/10/16/the-cost-of-developing-drugs-is-insane-a-paper-that-argued-otherwise-was-insanely-bad/#6c183d72d459

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